Understand Medicare Buy-In

• Accretions will be done on a daily basis.   We will receive responses from CMS to our accretions on a daily basis.
• Deletions will be done once a month during the first week of each month.
• Mainframe inquiry windows have been created to display data from the state Accretion and Deletion transactions as well as the CMS response records.  These will be accessed from the new Medicare Buy-In (MBI) icon on the Interface Main Menu.
• The buy-in system allows for Central Office staff to manually initiate a buy-in for Part A, Hospital Insurance, for selected client’s who are not entitled to free Part A coverage.
• The Medicaid eligibility groups have changed.  See details below

Part B Buy-In Eligibility Groups

Grant Clients:  ADC/MED participants have been added as buy-in eligible.  AABD/MED participants remain eligible.

Medicaid Poverty Level Clients:  All participants who are in Children’s Medical poverty level groups (CMAP), KC, and TMA have been added as buy-in eligible.  AABD related poverty level groups remain eligible, e.g.  QMB.

Medicaid Medically Needy Clients:  Beginning with the Medicare Buy-In Redesign we will begin paying the Part B premium for a  group of Medicaid participants  who have not been previously eligible for Buy-In.  These participants have Medically Needy (MN) category codes, some examples are AABD/MN-AA, AABD/MN-AD, ADC/MN-I, SIMP/MN-AA, and RIB.

The MED-MN participants who will be Medicare Buy-In eligible  must meet the following criteria –

1. Have net countable monthly income (this is the income after earned and unearned income disregards and allowable medical disregards) of less than or equal to 120% FPL, and
2. Living arrangement has no bearing on whether we buy-in for the client.
3. Be in Active or Spendown status.

In conjunction with the change in the Medicare Buy-In program there will be a change in the Expert System MED Budgeting rules on allowance of the Part B Medicare Premium as a Share-of-Cost Adjustment.  For the group of participants identified above, the MED Budgeting rules will NOT allow the Part B premium as a SOC adjustment since the premium will be paid by Medicaid.   These MED Budgets will be automatically adjusted for workers when the MESA process is run for the Federal Poverty Level changes.

(03-2011)